IN THE CASE OF:	  

		BOARD DATE:	  17 September 2014

		DOCKET NUMBER:  AR20140014262 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests a review of the military disability evaluation pertaining to a mental health (MH) condition.

2.  The applicant states, in effect, the case file should be reviewed in accordance with the Secretary of Defense directive for a comprehensive review of members who were referred for a disability evaluation between 11 September 2001 and 
30 April 2012 and whose mental health diagnosis was changed during that process.

3.  The applicant submitted an application through the DOD Physical Disability Board of Review (PDBR) Mental Health Special Review Panel (SRP).

CONSIDERATION OF EVIDENCE:

1.  The PDBR SRP conducted a comprehensive review of the applicant’s submissions and records for evidence of inappropriate changes in the diagnosis of a mental health condition during processing through the military disability system.  

2.  The Department of Defense memorandum, dated 27 February 2013, directed the Service Secretaries to conduct a review of mental health diagnoses for service members completing a disability evaluation process between 11 September 2001 and 30 April 2012 in order to determine if service members were disadvantaged by a changed diagnosis over the course of their physical disability process.
3.  In the processing of this case, an advisory opinion was obtained from the PDBR SRP and the applicant was provided a copy.

4.  The applicant did not respond to the advisory opinion.  

DISCUSSION AND CONCLUSIONS:

1.  After a comprehensive review of the applicant’s case, the SRP determined by unanimous vote that there should no change in the physical evaluation board (PEB) adjudication of the temporary disability and permanent retirement determination. 

2.  The SRP reviewed the records for evidence of inappropriate changes in
diagnosis of the MH condition during processing through the military Disability Evaluation System (DES).  The evidence of the available records shows a diagnosis of anxiety disorder not otherwise specified (NOS) and somatoform disorder NOS were rendered.  The SRP noted the neurology medical evaluation board (MEB) recorded the diagnosis of Post-Traumatic Stress Disorder (PTSD) and that the neuropsychological evaluation had not recorded a diagnosis of PTSD and PTSD had not appeared in any other clinical record in evidence prior to the Temporary Disability Retired List (TDRL) placement. 

3.  The SRP acknowledged the Department of Veterans Affairs (VA) examiner’s PTSD diagnosis 8 weeks after TDRL placement but found insufficient clinical evidence to support a PTSD diagnosis.  The examiner did not reference that any criteria was used to determine the PTSD diagnosis.  Likewise, a VA psychiatrist entered the diagnosis of PTSD during a routine follow-up visit approximately 2 months prior to the TDRL exit examination but failed to document that any criteria was used; no stressor was recorded.  There was insufficient evidence that the applicant met the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria for PTSD at any time.  The psychiatry narrative summary (NARSUM) and psychological tests results noted specifically that the applicant did not meet criteria for a PTSD diagnosis.  The SRP determined that the referred MH diagnoses were not changed in the disability evaluation system.  Therefore, the applicant did not appear to meet the inclusion criteria in the Terms of Reference of the MH Review Project.

4.  The SRP agreed that PEB adjudication of unfitting General Anxiety Disorder (GAD) with somatoform disorder NOS was supported by the evidence.  The PEB applied the VA Schedule for Rating Disabilities (VASRD) Section 4.129 at TDRL entry.  The SRP considered if there was evidence for a VASRD Section 4.130 rating higher than 50 percent at time of placement on the TDRL.  Available treatment records at the time leading up to TDRL entry recorded no history of suicidal ideation, one emergency room visit related to an anxiety attack, no acute inpatient psychiatric care, no history of violence, and no legal history.  The applicant spent about 90 days in a rehab inpatient program to address both mental and non-MH issues.  There was no evidence of impairment in judgment or thinking.  The commander’s statement noted occasional decrease in work efficiency and difficulty establishing and maintaining effective work relationships and that his verbal skills interfered with workplace interactions on most days; however, it did not indicate that applicant was a safety issue or presented a danger to others.  There was no indication that he behaved impulsively or irrationally.  The SRP considered the record in evidence best supported the 50 percent rating for TDRL entry and there was insufficient reasonable doubt (in accordance with VASRD Section 4.3) for recommending a TDRL entry rating higher than 50 percent.

5.  The SRP agreed at the time of permanent retirement that the record did not support a change in the diagnoses of GAD with comorbid somatoform disorder. The applicant was engaged socially with the Masons, bought a home, and was still taking psychotropic medications with no reported benefit.  Although the exit NARSUM examiner stated there was impaired insight and judgment, there was no evidence presented in the evaluation.  The applicant was never hospitalized psychiatrically; there was no report of suicidal or homicidal thought and no legal issues.  Additionally, although there were reports of panic attacks there was no evidence of visits to the emergency room for MH concerns. 

6.  After due deliberation in consideration of the preponderance of the evidence, the SRP concluded that there was insufficient cause to recommend a disability rating beyond the 70 percent granted. 

7.  The available evidence shows the SRP’s assessment should be accepted. 

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

_____X___  ____X____  ____X____  DENY APPLICATION




BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined that the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned.  




      ____________X___________
       	   CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.


ABCMR Record of Proceedings (cont)                                         AR20040003532



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ABCMR Record of Proceedings (cont)                                  AR20140014262



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